ICU Psychosis (cont.)

Maureen Welker, MSN, NPc, CCRN

Maureen Welker received a Bachelor of Science degree from California State University, Long Beach (CSULB) and also obtained a Public Health Nurse Certification. There she served as Vice President of the Graduate Nurses Association, at CSULB and also served as President of the Graduate Nurses Association. Ms. Welker is a board-certified Nurse Practitioner and is currently on staff at Mission Hospital Regional Medical Center.

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What is an example of a situation of ICU psychosis?

Years ago, when we went to visit my father-in-law in a hospital ICU, we found him disoriented and very depressed. He couldn't hear or see well. It was like being in a medically-induced whiteout. His room was windowless. He was unable to listen to a radio, watch television or talk on the telephone. He had virtually no human contact other than brief visits by medical staff because he was in isolation with an infection. The staff he did see were in mask and gown and all looked alike. He felt cut off from human contact. He was sure he was going to die (which he didn't). He had ICU psychosis.

It turned out that my father-in-law's customized hearing aid left lying on the nightstand had disappeared. It had apparently fallen into the waste basket and been thrown out with the trash. To safeguard his glasses, a well-meaning nurse suggested that his glasses be taken home. Hence, he could not hear or see much. Restoration of his hearing aid and glasses largely relieved his ICU psychosis.

Can ICU psychosis be dangerous?

Yes. To give another example, a friend fell seriously ill with a pulmonary infection some years ago, was very feverish, in considerable pain (from pleurisy) and felt just terrible. She was put in the hospital ICU and had a large-bore intravenous catheter with fluids running together with several antibiotics. She was also given some medications to relieve the pain let me catch up on sleep. She fell asleep but awoke in the middle of the night totally disoriented, very agitated, hallucinating, etc. She had pulled out the IV catheter and was spouting blood all over the place. She was experiencing ICU psychosis. While still in the hospital, a repeat dose of the pain medications led to a repeat episode of the ICU psychosis. ICU psychosis can be dangerous, even life-threatening. It is best avoided if possible.